The URL can be used to link to this page

Home My WebLink About5358-zFOEM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at ... ~11. ~ .~'1~ ........... Street Map No....1~.$.~..~...F.a~t~ck No ........... Lot No...~.~..~.~0. .... ~..~.t.~..h~..~......N.,.~..~. co~orms subst~ti~ly to the Application for B~ldMg Permit heretofore filed M ~is office dated ............ J~...~, 19...~p~u~t to w~ch Build~g Pe~it No.. ~.~. dat~ .......... ~e.. ~ ..., 19..~, was issued, ~d co~orms to ~1 of the r~e- ments of ~e applicable pro~sions of the law. The occup~cy for which ~ ce~fficate is ~sued is . ~$~.~. ~ .f~l~. ~$~ ...................................... The ce~icate is ~sued to .. ~9~ .~9~ ...... ~ ........................ (owner, lessee or ten~t) of ~e ~ores&d b~ding. . Suffo~ Co~ty Department of~ He~ Approv~ .... ~ .......................... ~.' ~' ...~.~~~.~.::.:.~.:.:...~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ' SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5358 Z Permission is hereby granted to: C~teh,~gue . ~o ~l~..,~..~..,,,~,.~.c~ .......... ~2 ....... l .................................................................................... at premises located at ,...~). ............................................ ................................................ ~.... Ave c..u,.t..e..~.e..~..~e.....) .............................. pursuan¢ to application doted .............. 'x'T~'2~ ........ ~J.~....(....., 19.~..~..., and approved by the Building Inspector. Fee $....~.'....(~.. ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................................. ~/ (~ · 19~ ( Application No. Approved " "' ~-~ ~'0~:: ~ ........................................ , 19 ........ Pemit No .................................... Disapproved o/c ........................................... 1.4_ ...... v ,~.,,. , ,,tBuilding Inspector) ~ APPLICATION FOR BUILDING PERMIT Date ....... ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot p an showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordi nonces, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) ............. (Address of applicant)'" State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...0....co. ................................................................................................................................... Name of owner of premises ..... ~.]~'.~:;~.....~..(~..........~....~X~..~....(~.....C~.....~ ...................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed ,wor~,~Jl~l be done. Map No.: ....IL.z.~.. ~ .Lot NO /, ~'~'~ Street and Number ...~.A..~.~ .............. ' Municipali~~ ~: ........... State existing use and occupancy of premises and intended use and ~cupancy of proposed construction: a. Exisiting use a~ ~cupancy ..... ~ ~~ ........... ~"....~.~. ............................ ~ .................................................. b. Intended use and ~cupancy ..... ~..~.t ......................... ~ ...................................................... _/ 3. Nature of work (check which applicable): New Building .................. Addition ....~............ Alteration .................. Repair .................. RemovaL .................. Demolition .................. Other Work (Describe} ........................................ 4. Estimated Cost ......... .~...~.O....O.. ...... Fee. ~..~....c~.. ............................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars .............. /. ................................................................................................................. . ........... 6. If business, Commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ....... .~....~.... ......... Rear ~ ~ .......... Depth .~.Z~. ........... Height .....,/,,~ ........... Number of Stories it' Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ...................... ~,..Number of Stories ............. · .................. 8. Dimensions of~e~ntire new construct on Front ..~.....~.... .. · Rear ... Height ...... ~...g ....... Number of Stories ..................................................................................................................... 9. Size of lot: Front ..... .~.....~... .............. Rear .......... ./....~...~ ................ DePth ..~.O.. .......... ' 10. Date of Purchase .......... ../....~....~....~... .................... Name of Former Owner ..~...~.~...~....~.../....~....~ ............ .11. Zone or use district in which premises are situated ............ 4~ ................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation;: 13. Name of Owner of premises .~....~..~?~.~....(~....(~..?..Address ..0.~.O~....~...O...~.~.~.....~y..... Phone N2.~..~..-..~..6..~...~ Name of Architect ..~}~/~ ........... Z;. ...................... Address .................... 'i'....i .................. Phone No ..................... Name of Contractor .~.....~....~/~.'.'.f.~,~. Address ...~....~'. ~/~...~..,~-~ ...... Phone No~..~..~....-'~......~'..~.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or descriptic~ according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, tS S COUNTY OF.... ~ .......... ~ ' ............................ ~g.~.~-~.......~.-e..t~.~.g.¢~.9.~ .............................. being duly sworn, d~es and says t~t he is the applicant (Name of individual signing a~lication) above named. He is the ........................................ o~a~ ................................................. (Contractor, ag~t, co~orate officer, etc.) of said owner or ~ners, and is duly authorized to perform or h~e perfo~ed the said work and to ~ke and file this application; that all statements contained in this applic~ion am tree to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the ~Plic~i~ filed therewith. Swam to before me this c" oun~ ~oz~tbre of applicant) ............ NOTARY PUBLIC, ~te of ~ew YmkYmk TArn ~ ~ ~,